Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts

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Objective Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. Methods We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. Results Cohort sizes ranged from ∼50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. Conclusion Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.

OriginalsprogEngelsk
Artikelnummere003027
TidsskriftRMD Open
Vol/bind9
Udgave nummer3
Antal sider15
ISSN2056-5933
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
The authors wish to thank all clinicians and patients contributing to the RA cohorts used for this investigation, and to past or present PIs of the RA data collection used, namely Lars Alfredsson (EIRA), Lars Klareskog (EIRA), the SRQ biobank group, Espen Haavardsholm (ARCTIC), Maria Dahl Mjaavatten (NOR-VEAC) and Tore K. Kvien (NORD-MARD). Thank you to all departments and patients contributing to the Danish DANBIO registry. We also thank colleagues contributing the Danish Rheumatologic Biobank (DRB): Oliver Hendricks, Estrid Høgdall, Søren Jacobsen, Dorte Vendelbo Jensen, Salome Kristensen, Asta Linauskas, Anne Gitte Loft, Heidi Lausten Munk, Inge Juul Sørensen, Torkell Ellingsen This project was supported by Vinnova, Innovationsfonden and The Research Council of Norway, under the frame of Nordforsk (Grant agreement no. 90825, Project NORA), the Swedish Research Council, the Region Stockholm-Karolinska Institutet research funds (ALF).

Funding Information:
This project was supported by Vinnova, Innovationsfonden and The Research Council of Norway, under the frame of Nordforsk (Grant agreement no. 90825, Project NORA), the Swedish Research Council, the Region Stockholm-Karolinska Institutet research funds (ALF).

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

ID: 384953047